Provider Demographics
NPI:1851408561
Name:FANNIN COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:FANNIN COUNTY HOSPITAL AUTHORITY
Other - Org Name:RED RIVER REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-583-8585
Mailing Address - Street 1:504 LIPSCOMB ST
Mailing Address - Street 2:P. O. DRAWER C
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4028
Mailing Address - Country:US
Mailing Address - Phone:903-583-8585
Mailing Address - Fax:903-640-7601
Practice Address - Street 1:504 LIPSCOMB ST
Practice Address - Street 2:P. O. DRAWER C
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4028
Practice Address - Country:US
Practice Address - Phone:903-583-8585
Practice Address - Fax:903-640-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008231282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1108490-01Medicaid
TX00C57TOtherBLUE CROSS BLUE SHIELD
00458ZMedicare ID - Type Unspecified